If there is one thing the U.S isn’t known for, it is its healthcare. With rising costs making healthcare unaffordable to a significant part of the population, we have to ask ourselves what’s going wrong.
The USA has been facing a crunch of primary care physicians for quite some time. By 2025, the total number of primary care physicians will rise 6% from 288,000 to 306,000. Yet, the shortage of primary care physicians could grow to 49,000 in 2030, up from 18,000 in 2018.
Another report published in AAMC puts the shortage to 120,000 by 2030 for both primary and specialty care. It has also been seen that only 1 out of 6 graduates choose a primary care residency program; that makes it 5,000 out of 30,000.
There are other facts about which we need to be concerned. Currently, more than 1/3 of all physicians working will be 65 or older by 2030. The field is also overworked- a physician who has a panel of 2,000 patients would require to spend 17.4 hours per day to meet the patient's needs. You also have to consider that primary care physicians have larger panels than that!
Since 2016, the USA has been producing many doctors to meet the demand of the population. But the higher number of medical students did not end up choosing primary care. Yet, the policymakers don’t seem to question the ‘more is a better approach when dealing with the supply of primary care physicians.
The time has come to choose alternative methods to correct the problem.
A Big Problem Facing the Country
When dealing with healthcare, lawmakers have often overlooked primary care. This, despite it being one of the most overworked and underpaid branches of healthcare. Subspecialties both for outpatient care and inpatient on-call physicians consider primary care as the dumping ground.
Gradually, we realize the importance of preventive medicine and health maintenance which is becoming complex. A similar case exists with value-based care, which will need greater attention. All of the activities come under the purview of the primary care physician. As a result, there will be increased overwork and burnout, and physicians will not meet the ever-increasing government mandates.
Now let’s explore why there is a declining trend in primary care physicians.
Primary care branches such as family practice, pediatrics, urgent care, internal medicine, psychiatry are not thought to be sophisticated medical fields. The residency programs have their monopoly over who gets to choose which specialty.
The specialties with fewer night calls, high compensation, the predictability of future workload, opportunities for cash-based expansion become the favorite. The eligibility for acceptance to specific fellowships and residency programs has not always been based on hard work and knowledge regarding choosing a subspecialty.
Residency programs don’t go by the rules of free-market and demand and supply. Even though there is high demand for primary care physicians, we are still facing a shortage; they are also underpaid and overworked.
What’s Wrong with the Picture?
To account for the shortage of qualified physicians, you can look to replace physicians with NPs. There is nothing wrong with the approach, but we will not address the cause of the problem.
We are only going to expand the limited scope of medicine against providing the service that primary health physicians can handle. The approach will upset the even distribution of standard of care across all socioeconomic and geographic borders.
Urgent care and retail medicine can improve the care at the primary level- this thought has been contemplated for a long. But it will not be possible in a profit-seeking corporate system that puts profit over personalized care. In a genuine, personalized sense, retail-style medicine is difficult to travel in states where managed care is dominant with favorable policies for the groups.
Primary care is the foundation of personalized, preventive, and precision medicine. They are the first line of contact with patients and also the final step after specialized care. They can be considered the project managers of treatment, working closely with the patient helping and providing support. Yet, they are overworked and not paid as high as other specialties.
We cannot divert foreign graduates to undeserving areas and primary care as it is a short-term solution. They will gradually move to metropolitan areas after a particular time.
We have to empower physicians and incentivize them so that they can stay independent. They need the resources and support to deliver health care to underserved communities available in overserved areas. Corporate lobbyist managed care and unilateral mandates have created an unfair monopoly that restricts passionate and professional physicians from serving in rural and underserved areas.
It isn’t a primary shortage, but a shortage of doctors who are not penalized for working extra and burnout. We face wide-scale corruption, and insurance companies are putting their nose amidst who works where and gets paid what. The Independent physician practice is crucial for underserved areas as it grants them medical access and the right to stay healthy.
To create healthcare without borders, we have to adopt a bottom-up approach with patient and doctor empowerment. We have to improve the remote patient facilities and network with independent physicians to develop a free accessible market for everyone. Physicians will have to validate the technology which will be used for the benefit of the patient.
We need to complement technology with hands-on support and strategies by physicians and patients with a genuine human touch. Let us join hands to remove the barriers to quality healthcare.